With the 3-day SNF rule back, look to build alliances to stay compliant
By: Roy Edroso
Encouraging results from the use of waivers to the Medicare three-day skilled nursing facility (SNF) rule have prominent health care authorities, including some within the federal health care bureaucracy, challenging the rule’s necessity. But the rule is probably not going away soon, so providers whose patients make heavy use of skilled nursing should consider alliances that will exempt them for it.
Consider updating enrollment, weigh security risks if you offer telehealth from home
By: Julia Kyles, CPC
Practitioners who perform telehealth from home (TFH) must update their enrollment before the end of the year. The COVID-19 public health emergency (PHE) waiver that allows physicians and non-physician practitioners (NPP) to bill for TFH under the practice’s address will expire Dec. 31, 2023. 
Crack the modifier 25 code: Clear confusion, review scenarios
By: Courtney Crozier, MA, RHIA, CCS, CDIP
The AMA published additional guidance for modifier 25 (Significant, separately identifiable E/M service by the same physician or other qualified healthcare professional on the same day of the procedure or other service) in its recent publication of CPT Assistant, released March 2023.
Part B News Features
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Question: One of our former physicians had his license pulled for passing “COVID misinformation” during the public health emergency (PHE). Now that the PHE is over, what are his chances of... More
NPP Report
Recent changes mandated by Congress and CMS that boost the status of physician assistants (PA) — or physician associates, as some groups prefer — is another sign that the providers formerl... More
Benchmark of the Week
Notwithstanding the pandemic waivers of the three-day rule, nursing facility E/M and discharge codes, used by skilled nursing facilities, mostly took a hit during the public health emergency (PHE).&nb... More
Ask a Part B News Expert
Question: One of our former physicians had his license pulled for passing “COVID misinformation” during the public health emergency (PHE). Now that the PHE is over, what are his chances of... More
NPP Report
Recent changes mandated by Congress and CMS that boost the status of physician assistants (PA) — or physician associates, as some groups prefer — is another sign that the providers formerl... More
Benchmark of the Week
Notwithstanding the pandemic waivers of the three-day rule, nursing facility E/M and discharge codes, used by skilled nursing facilities, mostly took a hit during the public health emergency (PHE).&nb... More
choose your feature view ► Ask Part B News & NPP Report Benchmark of the Week & Ask Part B News NPP Report & Benchmark of the Week
Part B News Blog
Jun 1, 2023
Facet joint interventions: OIG frowns on audit findings, prior auth goes live July 1
by: Julia Kyles, CPC
May 25, 2023
Cigna backs off on tough new modifier 25 policy – for now
by: Laura Evans, CPC
May 25, 2023
AMA previews E/M updates in 2024 and beyond
by: Julia Kyles, CPC
Tools
April 1, 2023 ICD-10-CM code file
Bring your staff up to date on the ICD-10-CM code changes that went into effect April 1.
Use new E/M coding worksheet for level-based E/M encounters
DecisionHealth has revised its tool for office/other outpatient E/M visits (99202-99215) to include encounters performed in the inpatient or observation (99221-99223 and 99231-99236), emergency department (99281-99285), nursing facility (99304-99310) and home or residence (99341-99350) settings and consults (99242-99245 and 99252-99255).
See more...
Benchmark of the Week
Pandemic cut most nursing facility E/M, but 99309 looks strong
Notwithstanding the pandemic waivers of the three-day rule, nursing facility E/M and discharge codes, used by skilled nursing facilities, mostly took a hit during the public health emergency (PHE). As noted by the Kaiser Family Foundation, there was a decline in SNF admissions during that period, though the length of SNF stays and spending increased.
Revenue up despite claims depression for psych, diagnostic codes
While mental health surfaced as a big topic during the COVID-19 crisis, most psychiatric evaluation and psychotherapy services didn’t see a major boost in claims. Nearly all saw a dip in utilization between 2019 and 2021, although the lone outlier grew enough, abetted by rate increases, that payments jumped more than $66 million.
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Learning Opportunities
WEBINAR
Webinar Facet Joint Interventions: Prepare for Prior Authorizations and More Medicare Audits
WEBINAR
Webinar Transition to a Post-PHE Era: Craft a Coding, Billing, and Compliance Plan
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